A 28-year-old primigravida at 32 weeks gestation comes to the labor room with complaints of headache, blurred vision, and edema in the hands and legs. On examination, her blood pressure is 160/100 mmHg, and a urine dipstick shows +3 proteinuria. What is the most likely diagnosis?

1. A

   Gestational hypertension

2. B

   Transient hypertension

3. C

   Preeclampsia

4. D

   Eclampsia

Appeared in: NORCET 9 Mains - 2025

Explanation

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• Preeclampsia is defined as new-onset hypertension (BP greater than or equal to 140/90 mmHg) occurring after 20 weeks of gestation, accompanied by proteinuria (greater than or equal to 300 mg/24h or a protein/creatinine ratio of greater than or equal to 0.3, or a dipstick of 1+).
• This patient meets the criteria with a BP of 160/100 mmHg and +3 proteinuria at 32 weeks of gestation.
• The presence of headache and blurred vision are considered symptoms of end-organ damage, specifically central nervous system perturbations, which categorize this as preeclampsia with severe features.
• While edema is common in normal pregnancy, its sudden onset in the hands and face, as seen in this patient, is often associated with preeclampsia.

Why Other Options Were Wrong

• Option A: Gestational hypertension is characterized by elevated blood pressure after 20 weeks of gestation without the presence of significant proteinuria.
• Option B: Transient hypertension is a retrospective diagnosis. It is used to classify hypertension that develops during pregnancy but resolves by 12 weeks postpartum, without the development of preeclampsia.
• Option D: Eclampsia is diagnosed when a patient with preeclampsia experiences generalized seizures (convulsions) that are not attributable to other causes.

Related Visual

• Visual 1: Comparison Table - A table differentiating Gestational Hypertension, Preeclampsia, and Eclampsia based on key features like blood pressure, proteinuria, and presence of seizures. This helps clarify the diagnostic criteria for each condition.
• Visual 2: Infographic - An infographic illustrating the signs and symptoms of preeclampsia, highlighting the 'red flag' symptoms like severe headache, vision changes, and upper abdominal pain that indicate severe disease.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Diagnosis of hypertensive disorders in pregnancy to guide bedside assessment, documentation, and the next nursing action.
• Recognizing preeclampsia is a critical nursing skill as it is a major cause of maternal and perinatal morbidity and mortality. Prompt identification allows for timely management to prevent progression to eclampsia and other severe complications.
• Nursing care for a patient with severe preeclampsia includes seizure precautions (padded side rails, oxygen/suction at bedside), frequent monitoring of vital signs and fetal heart rate, administration of magnesium sulfate for seizure prophylaxis, and antihypertensive medications.
• What if? - If this patient suddenly loses consciousness and begins to have tonic-clonic movements, the diagnosis immediately changes to Eclampsia. The nurse's first priority is to ensure patient safety, maintain a patent airway (turn patient to her side), administer oxygen, and call for immediate medical assistance. Magnesium sulfate would be administered as an anticonvulsant.

How to Approach the Question

• First, analyze the patient's demographic and clinical data: 28-year-old primigravida, 32 weeks gestation.
• Identify the key signs and symptoms presented in the scenario: headache, blurred vision, edema, BP 160/100 mmHg, and +3 proteinuria.
• Recall the diagnostic criteria for hypertensive disorders of pregnancy.
• Evaluate each option against the patient's presentation. Gestational hypertension is ruled out by the presence of significant proteinuria.
• Eclampsia is ruled out by the absence of seizures, although the symptoms are concerning for impending eclampsia.
• Transient hypertension is a retrospective diagnosis and cannot be made at this time.

Concept Tested & Keywords

• Concept Tested: Diagnosis of hypertensive disorders in pregnancy
• Stem keywords: primigravida, 32 weeks gestation, headache, blurred vision, edema, blood pressure 160/100 mmHg, +3 proteinuria
• Lead-in keywords: most likely diagnosis
• Clinical cues: The combination of hypertension (BP 160/100 mmHg), significant proteinuria (+3), and neurological symptoms (headache, blurred vision) after 20 weeks of gestation is the classic triad for preeclampsia, with features of severe disease.

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